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Why Adding Vitamin D May Not Help IBD

Despite all of the accolades that vitamin D has received, the fact that low vitamin D is associated with worse outcomes, in a number of disease states, does not prove causality. A recent article indicates that vitamin D is likely more of a marker of disease activity than a mediator of disease activity in inflammatory bowel disease (IBD), and specifically Crohn’s disease (CD) (Inflamm Bowel Dis 2014; 20: 856-60).

Background: Binding sites for the vitamin D receptor (VDR) have been “identified in genes associated with CD, and vitamin D has been shown to enhance the production of interleukin-10 (IL-10) and induction of regulatory T-cells.”

Design:The authors prospectively collected samples of 37 CD patients; the mean age in those with active disease (n=20) was 34 years and it was 30 years in those with inactive disease. In 8 patients with active disease, vitamin D levels were measured at the time of active inflammation (day 0) and at 14 days after receiving infliximab (day 14).

Key finding in these 8 patients: Vitamin D (25-OH) was 23 ng/mL on day 0 and 40 ng/mL 2 weeks later. Only 1 of these 8 patients was taking a vitamin D supplement.

Key finding in the entire cohort: in the active disease group mean vitamin D level was 27 ng/mL compared with 38 ng/mL in those in remission (P=0.02).

Take-home point: There is an inverse relationship between vitamin D levels and disease activity. However, the early increases in vitamin D levels with clinical response to anti-TNF therapy suggests that a major mechanism of vitamin D deficiency is related to the burden of systemic inflammation. Hence, repeat testing when patients are in remission may obviate the need for vitamin D supplementation in many patients.

Thank you for blogging on this salient topic, particularly within the context of IBD medical nutrition therapy. At Children’s Healthcare of Atlanta, we typically test the serum 25(OH)D values of all IBD inpatients upon admission for initial diagnosis or for follow-up with acute exacerbations.

I addressed our current inpatient practice of ordering D(25)OH levels for IBD patients in the throes of exacerbation to the Nutrition Support Colloquium audience after a presentation by Vitamin D researcher Dr. Vin Tangpricha; thankfully, Dr. Parminder Suchdev, staff physician and resident micronutrient researcher at the Centers for Disease Control, provided some additional perspective on this practice by referring to a recent publication in the Journal of Nutrition on a descriptive analysis of cross-sectional data for 29 biomarkers of diet and nutrition from a nationally representative sample of American adults participating in NHANES 2003–2006. The analysis revealed a 25(OH)D concentration 10% lower when CRP was elevated. Thus, delaying testing for vitamin D sufficiency until the IBD patient has achieved clinical remission in the outpatient environment appears prudent in light of this recent research.

You may find a synopsis of this Vitamin D presentation using the link below: